摘要
目的:为颈胸段前路手术中对喉返神经的定位和保护提供解剖学基础。方法:解剖40具成人颈胸部尸体标本,在颈胸段前路手术区对喉返神经进行解剖、观察和测量。结果:(1)左、右喉返神经颈内脏筋膜穿入点范围分别水平对应T2/3椎间盘、T3椎体(占85.0%)和C7/T1椎间盘、T1椎体(占87.2%);(2)颈部左、右侧喉返神经分别为94.5%、59.6%走行在气管食管沟内;左、右喉返神经在迷走神经的返折点范围分别水平对应T3/4椎间盘、T4椎体(占75.0%)和T1/2椎间盘、T2椎体(占82.5%);(3)非返性喉返神经1例,喉返神经的分支与颈交感干有交通2例,均出现在右侧;(4)左喉返神经10.0%在甲状腺下动脉之前,57.5%在其之后,32.5%在其分支之间;右喉返神经35.0%在动脉之前,22.5%在其之后,42.5%在其分支之间。结论:在颈胸段前路手术中,左、右侧入路分别在T2/3和C7/T1椎间盘水平以上操作是较安全的,但以采取左侧入路为宜,应注意喉返神经的变异。
Objective:To provide an anatomic basis for the location and protection of the recurrent laryngeal nerve (RLN) in the anterior approach of the cervicothoracic junction(CTJ).Method:Forty adult cadavers(80 sides) were collected at random for study.The RLN were dissected,observed and measured in the anterior region of the CTJ surgery.Resuit:(1)The entry point into the visceral fasciae of the left RLN locates at T2/3 disc,T3 level in 85.0% amd the right RLN at C7/T1 disc,T1 level in 87.2% respectively.(2)The rate of the left and right RLN location in the esophagotracheal groove was 94.5% and 59.6% respectively.The recurrent point of the left RLN located at 33/4 disc,T4 level of 75.0% with the right RLN at T1/2 disc,T2 level of 82.5%.(3)Non-recurrent laryngeal nerve appeared in 1 case;an anastomotic loop connecting the RLN and the cervical sympathetic chain appeared in 2 cases.Both of them were found on the right side. (4)On the right side,the RLN was found in front of the inferior thyroid artery in 35.0% of the cases,behind the artery in 22.5%,between the branches of the artery in 42.5%.On the left side,the RLN was found behind the artery in 57.5% ,in front of the artery in 10.0%,between branches the artery in 32.5%.Conclusion:It is safe for the right approach above C7/T1 disc in the anterior approach of the CTJ and for the left approach above T2/3 disc.The left-side approach is recommended in the anterior approach of the CTJ.The surgeon must be aware of the anomalies of the RLN in the CTJ surgery.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第2期130-133,162,共5页
Chinese Journal of Spine and Spinal Cord
关键词
颈胸段
手术入路
喉返神经
应用解剖
Cervicothoracic junction
Surgical approach
Recurrent laryngeal nerve
Practical anatomy